History questionnaire couple

Please write in the comment section your current profession / work position and in whatever applies to you.

Please let us know about any diagnosis that you have received from a psychiatrist or other therapist? 

Also any mental disorder that you might think you have (depression, anxiety, PTSD...).

If yes, please write in the comments section for how long you have been in therapy and what kind of therapy you are having.

Please indicate any prescription or non-prescription drugs in the comments section.

Please not in the comments section if any

Please state the total duration since the year you met. If you are married, separated or divorced, please also state for how many years.
Example: "12 years old, married for 3 years, separated for 6 months"

Do you live together as a couple?

Please indicate the number, gender and age of your children together.
e.g.: Three children, female (9,13), male (15)

Please briefly describe your own significant, multi-year relationships prior to your current relationship with approximate age information.
e.g.: partnership (22-28 years), marriage (29-42 years)

Please indicate the number of your own children from previous relationships, if any. Their gender, age and whether they live in your household. e.g.: Two children from his first marriage, son (13), daughter (15), with us every other weekend

Please select everything that applies to your current relationship. If the desire to have children was or is one-sided, please use the comment field to explain which of you has or had the desire. e.g.: My wish

Please briefly explain what you have done in your previous or current relationship.

If you have had any experience, what did you particularly like? Please use the comments section

What did not you like? What would you have liked to have been different?

Even though it may be difficult at the moment, remember the beginning of the relationship and write down 1-3 characteristics of your partner that you particularly liked then or still like. e.g.: "Creative, courageous and family-oriented" or "intelligent and loving" or "independent" etc.

Please briefly describe what you think. Name 1-3 of your qualities that you think your partner particularly likes or liked.

Please tick what applies to you personally

Please briefly describe what led you to the decision to seek support for your partnership. What do you see as the main problem or challenge for your partnership? If you are not in a crisis, for example if you have grown apart or are primarily interested in maintaining relationships or certain aspects of the partnership (communication, sexuality, tenderness), you can also describe this here.

Please briefly describe what trigger you suspect, if in your opinion there is one.

Please think about what resources you have available to you as a couple at the moment. Are there areas of life in which you agree?
Briefly describe when this happens and what is different then.
E.g.: "When it comes to the children, we always agree" or "When we are on vacation and can relax, we get along very well"

Imagine that you have processed everything that was important to you. What would be different between the two of you? What would there be more of, what less of? Please refer as much as possible to the partnership and your own goals and not to what you would like to have different about your partner.
Example: "Successful therapy would bring us closer together again and create new trust. We would also communicate more and better with each other. I would finally have the courage to address my needs instead of expecting people to guess them."

If you fill out this form it probably means we will have our first (online) session soon. We will send you the invoice for this together with our account details by email after the appointment. Please then transfer the amount to be paid. In order to create the invoice correctly, please let us know who we should address it to.

Since we might be holding our joint sessions via Zoom, we want to make sure that you have already installed the app and checked your video and audio. Then we don't lose valuable time on technical matters during the meeting. If you don't know your way around yet, we'll be happy to help.
We will send you the link for the session at least 15 minutes before the start of the session for the first session and it remains the same.

Please select everything that applies.

AGB zusammen wach 3_2021